Contextual Effect of the Integrated Non-Communicable Disease Health Post on the Performance of Community Health Workers: A Multilevel Analysis Evidence from Karanganyar, Central Java

Abstract

Background: Epidemiological transition is causing a shift from Communicable to Non­Communicable Diseases (NCD). NCD is a serious threat because it impacts decreasing productivity and increasing economic and social burdens for the community. The control of NCD risk factors in Indonesia is carried out by empowering the community through the Inte­grated Non­­-­­Com­municable Diseases Health Post (Posbindu NCD). One of the important factors determining the success of imple­menting Posbindu is the role of cadres. This study aims to analyze the factors that affect the performance of Posbindu cadres. Subjects and Method: This was an analytic obser­vational study with a cross-sectional design. The study was conducted in 25 posbindus in Karanganyar, Central Java, from February to April 2020. A sample of 200 cadres from 25 cadres was selected by stratified random sam­pling. The dependent variable was the perform­ance of the Pos­­bindu cadres. The independent variables were training, ability, length of em­ployment, motivation, the leader­­ship of the Posbindu chair­man, social network support and appreciation. Data were analyzed using multilevel logistic regression with Stata 13. Results: Job performance increa­sed with trai­ning (b= 1.75; 95% CI= 0.28 to 3.22; p= 0.019), good ability (b= 2.50; 95% CI= 0.95 to 4.04; p= 0.002)­, tenure ≥1 year (b= 1.99; 95% CI= 0.05 to 3.92; p= 0.044), strong moti­vation (b= 2.57; 95% CI= 1.25 to 3.89; p <0.001), good leadership of Posbindu chairman (b= 1.73; 95% CI= 0.44 to 3.03; p= 0.009), and strong social network support (b= 1.24; 95% CI= 0.14 to 2.34; p= 0.028). Incentive increased job performance, but it was statistically non-signi­ficant (b= 1.19; 95% CI= -0.35 to 2.73; p= 0.132). Posbindu had a strong contextual effect on job performance with an ICC of 62.73%. Conclusion: Job performance in­­creases with training, good abilities, tenure ≥1 year, strong moti­vation, good leadership of Posbindu chair­man, strong social network support, and appro­priate incentives. Posbindu has a strong con­textual effect on job perform­ance. Keyword s : performance, cadre, non-communi­cable disease Correspondence: Eka Siti Chasanah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ekas­c12@gmail.com. Mobile: +62­81329017587. Journal of Health Policy and Management (2020), 05(03): 204-214 https://doi.org/10.26911/thejhpm.2020.05.03.06